Objectives Infection with Trichomonas vaginalis has declined dramatically in urban Australia but remains endemic in some predominantly indigenous rural regions. The objective was to determine T vaginalis positivity rates in clinical specimens by PCR detection, from a large community-based private pathology laboratory servicing rural and urban Australian populations.

Methods Retrospective analysis of data from 44 464 specimens referred for T vaginalis PCR testing over 8 years from 2004 to 2011.

Results 44 464 consecutive specimens (37 137 female, 7242 male, 85 sex-unspecified) were analysed: T vaginalis was detected in 633 specimens. The overall community T vaginalis positivity rate was 1.4% (95% CI 1.3% to 1.5%). Overall rates were 2.1-fold higher in women than in men (1.5% vs 0.7%). Positivity rates were highest in the 10–14 year age group (p<0.0001). Referrals from urban areas of South-East Queensland accounted for 52% of specimens (23 121): the T vaginalis positivity rate in this urban cohort was 0.7% (95% CI 0.6% to 0.8%). Referrals identified to be from indigenous patients accounted for 48% of positive cases (304/633), and came from predominantly rural and regional areas of northern Queensland. Where follow-up testing was available 21% of patients (14/66) remained T vaginalis PCR positive when tested again within 3 months and 25% (26/101) within 6 months of the initial diagnosis.

Conclusions This study confirms that T vaginalis is rare in the urban non-indigenous Australian setting. Guidelines need to be developed to allow targeted testing. Follow-up testing 3 months after treatment should be considered.